肝切除术中低中心静脉压的收益与误区--“低肝静脉血流”理念的提出  

Benefits and Misunderstandings of LCVP in Hepatectomy(A Concept and Proposal of Intraoperative"Low Hepatic Venous Flow"Controlling)

作　　者：刘际童[1] 唐轶珣 LIU Ji-tong;TANG Yi-xun(Anesthesiology Center,Hunan Provincial People's Hospital(the First Affiliated Hospital of Hunan Normal University),Hunan Perioperative Enhanced Recovery Anesthesia Clinical Medical Research Center,Changsha 410005,Hunan,China)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)麻醉医学中心 [2]湖南省围术期加速康复麻醉临床医学研究中心,长沙410005

出　　处：《中国现代手术学杂志》2021年第5期324-327,共4页Chinese Journal of Modern Operative Surgery

基　　金：湖南省自然科学基金面上项目(2020JJ4404)。

摘　　要：对于肝切除术,特别是大范围的解剖性肝切除术而言,术中低中心静脉压(low central venous pressure,LCVP)是减少肝灌注、降低术中出血量的方法之一。然而,过于追求对LCVP绝对值的控制,可能会导致一系列的麻醉风险。本文通过介绍肝血管的解剖特点和肝血管舒缩调控的生理特点,提出“低肝静脉血流(low hepatic venous flow)”的理念比“低中心静脉压”更适合肝切除术中对肝脏血流的控制:切肝时应降低肝脏静脉容量血管的血流量,这才是避免创面出血的关键。为达到此目的,在控制总血容量的基础上(限制性输液、利尿剂排出多余容量),肝脏静脉应收缩而不是舒张,这样才能使肝脏血容量转移至体循环,而选择的血管活性药物应该是α受体激动剂(收缩静脉)而不是硝酸甘油(扩张静脉)。For hepatectomy,especially for majority anatomical hepatectomy,low central venous pressure(LCVP)is one of the managements to reduce liver perfusion and intraoperative hemorrhage.However,too much control over the absolute value of LCVP may lead to a series of anesthesia risks.By introducing the ana-tomical characteristics of hepatic vessels and the physiological characteristics of hepatic vascular regulation,the author points out that the concept of"low hepatic venous flow"is more suitable for the control of hepatic blood flow in hepatectomy than"low central venous pressure".The hepatic venous flow should be reduced during hepatectomy,which is the key to avoid massive bleeding.In order to achieve this goal,on the basis of control-ling the total blood volume(limited infusion,diuretic discharge of excess volume),the hepatic vein should contract rather than relax,so as to transfer the hepatic blood to the systemic circulation,and the vasoactive drug should beαreceptor agonists(constricting veins)rather than nitroglycerin(dilating veins).

关 键 词：肝切除术 控制性低中心静脉压 低肝静脉血流 

分 类 号：R657.3[医药卫生—外科学] R614[医药卫生—临床医学]